Utilization Management Specialist - Remote

Overview

The Utilization Management Clinical Specialist will play an important role in SmarterDx’s next product launch in the Utilization Management and Case Management space. This role will work closely with Product and Data Science to design and refine strategies that help hospitals optimize resource use, ensure appropriate levels of care, and support timely and effective patient management.

In Short

• Review and refine AI-generated determinations of medical necessity, level of care, and patient status.
• Collaborate with cross-functional teams to define and validate rules that identify care transitions.
• Support the design of clinical workflows for real-time decision-making.
• Translate utilization review standards into product requirements.
• Serve as a subject matter expert for patient status and care coordination documentation.

Requirements

• Strong background in utilization management or case management in an acute care setting.
• Deep knowledge of CMS 2-Midnight Rule and related guidelines.
• Familiarity with tools such as InterQual or MCG.
• Prior experience in advising healthcare technology companies.

Benefits

• Comprehensive Medical, Dental & Vision plans.
• Free One Medical Membership included.
• Up to 12 weeks of paid parental leave.
• Remote-First Team with a $400 home office reimbursement stipend.
• Unlimited PTO & 10 Holidays.
• $500 Learning & Development Budget per year.
• 401(k) with Traditional & Roth Options.
• Minimal Bureaucracy in a fast-moving environment.
• Work alongside supportive and mission-driven colleagues.